Discrim-A-Gon

The Discrim-A-Gon is a set of two plastic

disks, each containing a series of pegs, spaced at
varying intervals, from one to fifteen millimeters
apart. 20 and 25 mm. spacing is also given. Each
disk contains, on both sides, a friction grid to permit
ease of rotation. This can be rotated between a single prong for testing one-point and any of the other
spaced prongs for testing two-point intervals and between two different two-point intervals with ease.
Any of the two-pronged pegs at the larger intervals
can be used as the one-point tester without rotating
back to the single prong side of the disk.

Measurement of Two-Point Discrimination

The moving two-point discrimination test will evaluate the innervation density of the quickly-adapting
fiber/receptor system (just as vibration tests would
assess the threshold of this fiber system). The static
two-point discrimination test will evaluate the innervation density of the slowly-adapting fiber/receptor
system (just as the Semmes-Weinstein monofilaments will evaluate the threshold of this fiber system). Thus the moving two-point will assess hand
function requiring moving touch, e.g., object identification (tactile gnosis), buttoning a button, fine discriminative or manipulative tasks. Static two-point
discrimination will assess hand function requiring
precision sensory grip and constant touch, e.g. hold-

ing a pencil to write, a needle to sew or a key to put

into a lock. In order to adequately evaluate hand
function, both fiber/receptor systems should be evaluated with moving and static two-point discrimination.
For testing moving two-point discrimination, the
Discrim-A-Gon prongs are placed at the level of
the distal interphalangeal joint and moved slowly toward the tip of the finger, i.e., from proximal to distal (see photo). The prongs are placed exactly
perpendicular to the long axis of the finger. The purpose of the test is to determine the innervation density of the quickly adapting fiber/receptor system in
the area tested. This can be done when the two
points stimulate different areas adjacent to each
other. As most fingers are not wider than twelve to

fourteen mms., if a person cannot distinguish moving two points at these distances, the test is completed an no larger values are recorded (unless a
larger surface, such as the pulp of the toe or the dorsal-radial aspect of the hand is being tested).
For the two-point discrimination test, the DiscrimA-Gon prongs are also held perpendicular to the
long axis of the finger. When measuring static twopoint discrimination, if values exceed the width of
the finger, the two prongs can be placed so that they
are parallel to the long axis of the finger. If the distances of greater than 15 mms. are obtained, the
tester is essentially testing the tip of the finger
against the middle or proximal phalanx of the finger.
This type of information is useful for determining the

ability of the fingers, not the fingertip, to perform

gross sensory grips, or grasping functions.
The Discrim-A-Gon is placed upon the skin
only with sufficient pressure for a patient to determine that he is being stimulated, not to cause pain.
With some nerve problems, such as early in the
course of neural regeneration or with advanced
nerve compression, when the threshold for sensory
stimuli is greatly increased, the Discrim-A-Gon
must be pressed onto the surface of the finger with
greater force so that the stimulus is perceived. If the
stimulus is not pressed sufficiently in proportion to
the increased threshold, then a false-negative result
or an under-estimation of th patients true innerva-

tion density will be obtained. The examiner will know

that he is near the patients discrimination level
when the patient begins to move his finger up toward the prongs or asks the examiner to push a little harder, or says he feels one wide point. the
examiner should try to determine the patients discrimination value with as few trials as possible so as
not to fatigue the patients attention span. The stimuli are also given slowly with a short pause between
tests so as not to fatigue the patient's attention span,
and alternation between a one and two-point stimulus. When we have determined what we think is the
patient's two- point value, we use two correct answers of of three empirically as the tests endpoint.

Diagnostic Uses of the Discrim-A-Gon

The Discrim-A-Gon will be useful for measuring the innervation density of any surface area, not
just the fingertip. They are useful for determining
sensation after a nerve injury and nerve repair; following the progress of the repair; in the diagnostic
evaluation of a person with a possible nerve injury,
such as nerve division or nerve compression; and
for testing areas of skin before and after transfer to
resurface or construct other areas of the body.
Therapeutic Uses of the Discrim-A-Gon
The Discrim-A-Gon may be given to a patient
to take home with him as a sensory re-education
tool, just as therapeutic putty, clay or play dough are

used in motor rehabilitation. As such, it can be used

in the patients sensory re-education program and
for a patient's assistant, family member, or friend to
check his progress at home. The patient is instructed to use the Discrim-A-Gon frequently during the day. In early-phase re-education, he can
learn to distinguish the smooth from the friction grid,
and from the raised letter portion of the disk itself. In
late-phase re-education, beginning with the disk
with the larger divisions, the patient can attempt to
distinguish a difference between one or two points
moving along his finger. He may not initially recognizer the two prongs as two separate stimuli but may
yet be able to perceive that the two points feel different than one point. He is encouraged to work

with the Discrim-A-Gon until he can distinguish

this difference with the prongs spaced at increasingly narrower intervals.
References:
Dillon AL: Moving two-point discrimination test: Clinical evaluation of the quickly-adapting fiber-receptor
system. J. Hand Surg 3:478-481, 1978.
Dillon AL: Evaluation of Sensibility and re-education
of Sensation in the Hand. Williams and Wilkins, Baltimore, 1981.
Mackinnon SE, Dillon AL: Two-point discrimination
tester. J. Hand Surg 10A:906-907, 1985.

Dillon AL, Mackinnon SE, Crosby PM: Reliability of

two-point discrimination testing. J Hand Surg
12A:693-6, 1987.

2-point

Discrim-A-Gon
Model 12-1492

Mackinnon SE, Dillon AL: Surgery of the Peripheral

Nerve, Thieme, New York, 1988.
Crosby PM, Dillon AL: Comparison of two-point discrimination testing devices. Micro Surg: 10:134-137,
1989.
Dillon AL. Sensory Re-education after fingertip injury in Foucher G, ed. Fingertip: nailbed injuries,
Churchill Livingstone, London 1989.

INCLUDES TWO DISKS

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